# Tethered Cord Syndrome and Its Association With Cardiovascular and Other Anomalies: Insights From a Prospective Observational Cohort of 60 Cases

## TL;DR

This study examines tethered cord syndrome in 60 patients, finding that early surgery improves neurological and urinary function, and highlights the need for multidisciplinary care and routine cardiac screening.

## Contribution

The study provides new insights into the association of tethered cord syndrome with cardiovascular anomalies and emphasizes the importance of multidisciplinary management.

## Key findings

- Cardiac anomalies were found in 35% of patients through echocardiographic screening.
- Early surgical intervention significantly improved urinary and motor function (81.25% and 90% improvement, respectively).
- Multidisciplinary care was critical for addressing the complex, multisystem nature of tethered cord syndrome.

## Abstract

Background

A tethered cord is a neurological condition characterized by an abnormal attachment or tension of the spinal cord, which restricts its movement within the spinal canal. This dysfunction can lead to progressive neurological, orthopaedic, and urological symptoms. The clinical presentation and outcomes can be highly variable and associated with other system abnormalities, necessitating careful diagnosis and individualized management strategies. This study aims to define the clinical presentation along with associated cardiac and other spectrum, surgical outcomes, and the necessity for multidisciplinary management in tethered cord syndrome (TCS).

Materials and methods

A prospective cohort of children and young adults (age 1 year to 25 years) with clinically and radiologically confirmed TCS on MRI underwent baseline clinical, imaging, and echocardiographic evaluation. All received individualized detethering surgery, followed by standard postoperative assessments, including neurological, urological (with urodynamics and quality-of-life evaluations), and cardiac assessments. Patients had longitudinal follow-up for functional outcomes, complications, and recurrence, with strong multidisciplinary involvement throughout.

Results

The cohort demonstrated a male predominance with a broad spectrum of systemic anomalies. Cardiac anomalies were identified in 21 (35%) of patients via routine echocardiographic screening. Outcomes were analysed using descriptive statistics, and pre-/post-operative comparisons employed paired t-tests or Wilcoxon signed-rank tests as appropriate for continuous variables. Categorical outcomes were assessed using the chi-squared test. Reported improvement rates (urinary, motor) reached statistical significance (p < 0.05). The median duration of follow-up was 16 months (range 12-24 months). Quality of life (QoL) was measured using the PedsQL™ pediatric quality of life inventory, a validated tool for children, and the International Prostate Symptom Score for young adults. Multidisciplinary management involved neurologists, neurosurgeons, urologists, orthopedic surgeons, and cardiologists, with scheduled follow-ups at three months, six months, and one year in the first year and semi-annual visits thereafter. Early surgical intervention led to significant neurological and functional improvements (p = 0.02), particularly in urinary function (an 81.25% improvement) and motor deficits (a 90% improvement). Quality of life measures corroborated these findings. Each specialty contributed to integrated assessment and individualized care planning.

Conclusion

Tethered cord is a complex, predominantly paediatric syndrome with multisystem involvement requiring more than neurosurgical attention. Routine cardiac and renal screening should be integrated into diagnostic protocols to uncover occult comorbidities. Early surgical management yields meaningful improvements in function and quality of life. Long-term, multidisciplinary care models are critical to address the holistic needs of TCS patients. Major limitations of the study include the single-centre design, moderate cohort size, limited generalizability to diverse populations, and lack of genetic testing. Future multicenter studies with larger cohorts are needed to refine genotype-phenotype correlations and optimize management strategies.